Clinical presentation, diagnostic findings and management of cerebral ischemic events in patients on treatment with non-vitamin K antagonist oral anticoagulants - A systematic review.
- Meinel TR Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
- Frey S Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
- Arnold M Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
- Kendroud S Department of Neurology, Touro University California, Vallejo, California, United States of America.
- Fischer U Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
- Kaesmacher J Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
- Heldner MR Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
- Jung S Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
- 2019-03-30
Published in:
- PloS one. - 2019
Administration, Oral
Anticoagulants
Atrial Fibrillation
Brain Ischemia
Endovascular Procedures
Female
Humans
Ischemic Attack, Transient
Male
Reperfusion
Risk Factors
Stroke
Thrombolytic Therapy
Vitamin K
English
BACKGROUND
Non-vitamin K antagonist oral anticoagulants (NOAC) are equally or potentially superior in terms of effectiveness in the prevention of ischemic stroke and carry a lower associated risk of intracranial hemorrhage compared to Vitamin K antagonists. Nevertheless, ischemic strokes also occur in patients who are being treated with NOAC. In those particular patients, knowledge about the underlying stroke etiology, clinical presentation, acute management, and complication rates is scarce.
OBJECTIVE
Systematic literature review to provide a comprehensive clinical overview in terms of presentation, laboratory, imaging parameters and outcomes of patients suffering from acute cerebral ischemic events (i.e. TIA and acute ischemic stroke) while on treatment with a NOAC. Only if available, comparison to VKA is presented which was not the primary focus of this analysis.
DATA SOURCES
PubMed/MEDLINE, Scopus and EMBASE from January 1, 2006, to November 20, 2018.
STUDY ELIGIBILITY CRITERIA
52 studies providing detailed information on a total of 12247 patients were included. We excluded case reports and case series with less than five patients.
STUDY APPRAISAL AND SYNTHESIS METHOD
We systematically assessed study quality using a bias tool and pooled consistent data.
RESULTS
Existing data indicates milder stroke severity and smaller infarct size of acute ischemic stroke on treatment with NOAC compared to stroke occurrence on Vitamin K antagonists (VKA). Established risk factors for ischemic events also play a role in stroke while on NOACs, albeit the underlying etiology remains poorly understood. Intravenous thrombolysis and endovascular therapy seem to be safe and effective, but patient selection for recanalization therapies is challenging.
LIMITATIONS
Limited quality of published data, duplicate cases, statistical issues of data pooling, possible incomplete retrieval of identified research and reporting bias might have limited our findings.
CONCLUSIONS
Acute ischemic events despite treatment with NOAC therapy are insufficiently investigated.
SYSTEMATIC REVIEW REGISTRATION NUMBER
PROSPERO: CRD42018074853.
Non-vitamin K antagonist oral anticoagulants (NOAC) are equally or potentially superior in terms of effectiveness in the prevention of ischemic stroke and carry a lower associated risk of intracranial hemorrhage compared to Vitamin K antagonists. Nevertheless, ischemic strokes also occur in patients who are being treated with NOAC. In those particular patients, knowledge about the underlying stroke etiology, clinical presentation, acute management, and complication rates is scarce.
OBJECTIVE
Systematic literature review to provide a comprehensive clinical overview in terms of presentation, laboratory, imaging parameters and outcomes of patients suffering from acute cerebral ischemic events (i.e. TIA and acute ischemic stroke) while on treatment with a NOAC. Only if available, comparison to VKA is presented which was not the primary focus of this analysis.
DATA SOURCES
PubMed/MEDLINE, Scopus and EMBASE from January 1, 2006, to November 20, 2018.
STUDY ELIGIBILITY CRITERIA
52 studies providing detailed information on a total of 12247 patients were included. We excluded case reports and case series with less than five patients.
STUDY APPRAISAL AND SYNTHESIS METHOD
We systematically assessed study quality using a bias tool and pooled consistent data.
RESULTS
Existing data indicates milder stroke severity and smaller infarct size of acute ischemic stroke on treatment with NOAC compared to stroke occurrence on Vitamin K antagonists (VKA). Established risk factors for ischemic events also play a role in stroke while on NOACs, albeit the underlying etiology remains poorly understood. Intravenous thrombolysis and endovascular therapy seem to be safe and effective, but patient selection for recanalization therapies is challenging.
LIMITATIONS
Limited quality of published data, duplicate cases, statistical issues of data pooling, possible incomplete retrieval of identified research and reporting bias might have limited our findings.
CONCLUSIONS
Acute ischemic events despite treatment with NOAC therapy are insufficiently investigated.
SYSTEMATIC REVIEW REGISTRATION NUMBER
PROSPERO: CRD42018074853.
- Language
-
- English
- Open access status
- gold
- Identifiers
-
- DOI 10.1371/journal.pone.0213379
- PMID 30925155
- Persistent URL
- https://sonar.ch/global/documents/185115
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